Project Summary This is an application for a K23 Mentored Career Development Award for Dr. Katherine Lynch, a nephrologist at Beth Israel Deaconess Medical Center in Boston. Dr. Lynch's goal is to become a patient outcomes-oriented independent clinical investigator and epidemiologist by studying olfactory and taste impairment in people with advanced chronic kidney disease. The K23 award will provide Dr. Lynch with the support to accomplish the following goals: 1) to obtain protected time dedicated to research, 2) to gain expertise in the design and implementation of prospective studies, 3) to become experienced in assessment of nutritional status, and 4) to gain additional experience with advanced statistical methods through formal coursework and research. To attain these goals, Dr. Lynch has the support of her primary mentor, Dr. Gary Curhan, who is a leading nephrologist and epidemiologist and an experienced mentor, and her Advisory Committee consisting of Dr. Richard Doty, the Director of the Smell and Taste Center at the University of Pennsylvania Medical Center and an expert in the assessment of olfaction and taste; Dr. Bruce Bistrian, an expert in nutritional assessment and the Chief of Clinical Nutrition at Beth Israel Deaconess Medical Center; and Dr. Mark Williams, the Medical Director of the Brookline DaVita Dialysis unit, and an experienced clinician and researcher who cares for patients with advanced chronic kidney disease. Dr. Lynch will also make use of a variety of resources available to her through Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Harvard Catalyst (CTSA), and the Harvard T.H. Chan School of Public Health including ongoing biostatistical consultation via the Harvard Catalyst. Her career development will be further supplemented by attendance at scientific meetings, regular attendance at research conferences, advanced coursework, and her clinical activities. Malnutrition is an important complication of advanced chronic kidney disease. Dr. Lynch's research will focus on understudied contributors to malnutrition: impairments of olfaction and taste. Using data from NHANES (Aim 1), Dr. Lynch will conduct analyses to evaluate the association between level of renal function and prevalence of impairment of olfaction and taste. Among those who have chronic kidney disease, she will evaluate the association between each sensory impairment and potential risk factors and between each sensory impairment and markers of nutritional and functional status. She will also conduct a prospective cohort study (Aim 2) enrolling 135 people on hemodialysis to longitudinally assess olfaction and taste and their association with nutritional and functional status. Additionally, within the cohort study, Dr. Lynch will evaluate potential modifiable risk factors for olfactory and taste impairment. This research will prepare her to apply for an R01 grant with the goal of improving the nutritional status of patients with advanced chronic kidney disease.